M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States.
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Heart Lung. 2023 May-Jun;59:165-172. doi: 10.1016/j.hrtlng.2023.02.011. Epub 2023 Feb 24.
There is considerable heterogeneity in symptom burden among lung transplant candidates that may not be explained by objective measures of illness severity.
This study aimed to characterize symptom burden, identify distinct profiles based on symptom burden and illness severity, and determine whether observed profiles are defined by differences in social determinates of health (SDOH).
This was a prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). MSAS subscale (physical and psychological) scores range 0-4 (higher=more symptom burden). The lung allocation score (LAS) (range 0-100) was our proxy measure of illness severity. The MSAS subscales and LAS were used as continuous indicators in a latent profile analysis to identify distinct symptom-illness severity profiles. Comparative statistics were used to identify SDOH differences among observed profiles.
Among 93 candidates, 3 distinct symptom-illness severity profiles were identified: 71% had a mild profile in which mild symptoms (MSAS physical 0.49; MSAS psychological 0.57) paired with mild illness severity (LAS 38.59). Of the 29% mismatched participants, 9% had moderate symptoms (MSAS physical 0.88; MSAS psychological 1.47) but severe illness severity (LAS 88.02) and 20% had severe symptoms (MSAS physical 1.30; MSAS psychological 1.94) but mild illness severity (LAS 42.13). The two mismatch profiles were younger, more racially diverse, and had higher psychosocial risk scores.
Symptom burden is heterogenous, does not always reflect objective measures of illness severity, and may be linked to SDOH.
肺移植候选人的症状负担存在很大差异，这些差异可能无法用疾病严重程度的客观指标来解释。
本研究旨在描述症状负担，根据症状负担和疾病严重程度确定不同的特征，并确定观察到的特征是否由健康社会决定因素（SDOH）的差异定义。
这是一项对成年肺移植候选人的前瞻性研究。在移植前 3 个月内使用 Memorial 症状评估量表（MSAS）评估症状。MSAS 亚量表（身体和心理）得分为 0-4（得分越高，症状负担越重）。肺分配评分（LAS）（范围 0-100）是我们衡量疾病严重程度的替代指标。MSAS 亚量表和 LAS 被用作潜在剖面分析中的连续指标，以确定不同的症状-疾病严重程度特征。比较统计学用于确定观察到的特征之间的 SDOH 差异。
在 93 名候选人中，确定了 3 种不同的症状-疾病严重程度特征：71%的患者具有轻度特征，其轻度症状（MSAS 身体 0.49；MSAS 心理 0.57）与轻度疾病严重程度（LAS 38.59）相关。在 29%的不匹配参与者中，9%的患者有中度症状（MSAS 身体 0.88；MSAS 心理 1.47）但严重疾病严重程度（LAS 88.02），20%的患者有严重症状（MSAS 身体 1.30；MSAS 心理 1.94）但轻度疾病严重程度（LAS 42.13）。这两个不匹配的特征更年轻，种族更加多样化，且心理社会风险评分更高。
症状负担存在异质性，并不总是反映疾病严重程度的客观指标，并且可能与 SDOH 相关。
